• Dario Consonni1

  1. Clinica del lavoro, Milano

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LAVORO Periodo 1 novembre 2012 – 15 gennaio 2013

Ricerca bibliografica periodo dal 1 novembre 2012 al 15 gennaio 2013

Per leggere le caratteristiche di questa ROUTINE di ricerca clicca qui

Stringa: ("occupational exposure"[MeSH Terms] OR "occupational diseases"[MeSH Terms]) OR "occupational health"[MeSH Terms]) OR "workplace"[MeSH Terms]) OR "accidents, occupational"[MeSH Terms]) OR "employment"[MeSH Terms]) OR occupation[Title/Abstract]) OR occupational[Title/Abstract]) OR worker[Title/Abstract]) OR workers[Title/Abstract]) AND ("italy"[MeSH Terms] OR "italy"[All Fields]) AND ("2012/11/01"[PDAT] : "2013/01/15"[PDAT])
1. Rosecrance J, Marras T, Murgia L, Tartaglia R, Baldasseroni A. Carpal tunnel syndrome among ewe dairy farmers in Sardinia, Italy. Am J Ind Med. 2013 Jan 8. doi: 10.1002/ajim.22153. [Epub ahead of print]
Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado.

BACKGROUND: The region of Sardinia, Italy is known internationally for the production of cheeses made from ewe's milk. Although the use of automated milking equipment is available in ewe dairy operations, traditional hand milking is still performed on many ewe farms. The purpose of this study was to evaluate the prevalence of carpal tunnel syndrome (CTS) among farmers that manually milk ewes. METHODS: Worker demographics, upper limb symptoms, and electrophysiologic studies were obtained on 76 ewe farmers recruited from a random sample of 109 in northern Sardinia. Characteristic hand symptoms and electrophysiologic studies were used in the case definition of CTS. RESULTS: Of the 76 farmers evaluated, 42 (55.3%) fit the case definition of CTS in at least one hand. Assuming that all non-respondents did not have CTS, the CTS prevalence ratio would have been 38.5% (42/109) among the randomized sample of ewe farmers. CONCLUSIONS: These findings suggest that CTS is a significant occupational health issue for ewe farmers that continue the traditional methods of manual milking. The recent trend in automated ewe milking machines may help reduce the prevalence of CTS among the next generation of Italian ewe farmers.

Breve commento a cura di Dario Consonni
Lo studio è stato effettuato su un campione casuale di addetti alla mungitura manuale delle pecore. Si è evidenziata una elevatissima (55% sul totale dei partecipanti, quindi almeno il 40% tenendo conto della quota dei non partecipanti) frequenza di casi di sindrome del tunnel carpale (diagnosi documentata con esami elettrofisiologici).

2. Ciarrocca M, Capozzella A, Tomei F, Tomei G, Caciari T. Exposure to cadmium in male urban and rural workers and effects on FSH, LH and testosterone. Chemosphere. 2013 Jan 2. pii: S0045-6535(12)01299-4. doi: 10.1016/j.chemosphere.2012.10.060. [Epub ahead of print]
Department of Occupational Medicine, "Sapienza" University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.

OBJECTIVE: This cross-sectional study was conducted to assess the relationship between exposure to cadmium and circulating reproductive hormone levels in urban and rural male workers. MATERIALS AND METHODS: Urinary cadmium, blood cadmium, luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone were obtained from 86 non-smoking traffic policemen and 86 subjects working as roadmen in a rural area. All subjects were monitored to evaluate airborne exposure to cadmium. RESULTS: The mean value of exposure to cadmium was 1.3ngm(-3) in traffic policemen, while the mean value was less than 0.5ngm(-3) in roadmen. The mean concentrations of urinary cadmium (1.4 vs. 0.9μgg(-1) creatinine; p=0.001), blood cadmium (1.1 vs. 0.7μgl(-1); p=0.000), FSH (2.6 vs. 3.2μlUml(-1); p=0.02) and LH (2.6 vs. 3.1μlUml(-1); p=0.03) were significantly different between traffic policemen and roadmen. No differences were found in the mean values of testosterone between the two groups. Multiple linear regression models showed associations between (a) urinary cadmium, airborne cadmium, working life, job category and consumption of water from water supply (b) blood cadmium, airborne cadmium and job category (c) the values of FSH and age, working life, job category, urinary cadmium and blood cadmium (d) the values of LH and both the age and working life. CONCLUSION: The above results must be confirmed by further studies, but they indicate the influence of exposure to the cadmium present in urban air on the circulating FSH, even at low doses.

3. Filiberti R, Marroni P, Mencoboni M, Mortara V, Caruso P, Cioè A, Michelazzi L, Merlo DF, Bruzzone A, Bobbio B, Del Corso L, Galli R, Taveggia P, Dini G, Spigno F. Individual predictors of increased serum mesothelin in asbestos-exposed workers. Med Oncol. 2013 Mar;30(1):422. doi: 10.1007/s12032-012-0422-6. Epub 2013 Jan 1.
Epidemiology, Biostatistics and Clinical Trials, IRCCS AOU San Martino-IST - Istituto Nazionale per la Ricerca sul Cancro, Largo Rosanna Benzi, 10, 16132, Genoa, Italy,

The soluble mesothelin-related peptide (SMRP), a candidate marker for screening of subjects with asbestos exposure, is influenced by some individual and clinical factors. The aim of this study was to quantify the role of age, smoking, weight, presence of diseases and exposure to asbestos on serum SMRP levels in a large series of subjects exposed to asbestos, possible candidates for mesothelioma screening. One thousand seven hundred and four participants underwent clinical examination and were interviewed on medical anamnesis, occupation, smoking and weight. SMRP was measured by an ELISA assay. Overall, median SMRP was 0.4 (IQR 25-75: 0.3-0.7) nmol/l. It was higher in current smokers and in subjects with a cumulative asbestos exposure >50 ff/cc/years than in all the other subjects (p < 0.001 and p = 0.002, respectively). SMRP was positively correlated with age (ρ = 0.11, p < 0.001) and, inversely, with BMI (ρ = -0.15, p < 0.001). SMRP was lower in healthy subjects (n = 1,217: median 0.4 nmol/l) than in subjects with malignant tumors (n = 118: 0.5 nmol/l; p = 0.01), asbestos-related pleural lesions (plaques or thickenings, n = 152: 0.6 nmol/l; p < 0.001) and other benign diseases (n = 182: 0.5 nmol/l; p = 0.04). Multivariate analysis revealed significant predictors of increased SMRP: age >57 years, current smoking, a positive anamnesis for cancer and for asbestos-related pleural lesions, and BMI < 25. Some clinical and demographic variables are associated with serum SMRP levels. The degree of these associations is low, nevertheless they should be accounted for in the interpretation of SMPR as a candidate marker predictive of mesothelioma. The potential predictive value of serum SMRP in screening/surveillance programs must be validated in prospective studies.

4. Zanardi F, Salvarani R, Cooke RM, Pirastu R, Baccini M, Christiani D, Curti S, Risi A, Barbieri A, Barbieri G, Mattioli S, Violante FS. Carcinoma of the Pharynx and Tonsils in an Occupational Cohort of Asphalt Workers. Epidemiology. 2013 Jan;24(1):100-103.
From the aSection of Occupational Medicine, Department of Internal Medicine, Geriatrics and Nephrology, Alma Mater Studiorum-University of Bologna, Bologna, Italy; bOccupational Health Unit, Bologna Local Health Authority, San Giorgio di Piano, Bologna, Italy; cDepartment of Biology and Biotechnology "Charles Darwin," La Sapienza University of Rome, Rome, Italy;dDepartment of Statistic, University of Florence, Florence, Italy; eHarvard University, Environmental Health and Epidemiology Departments, Boston, MA; and fOccupational Medicine Service, Alma Mater Studiorum-University of Bologna, Bologna, Italy.

BACKGROUND:: We investigated a possible association between pharyngeal/tonsillar carcinoma and mixed carcinogen exposures in an asphalt roll company in Italy that used asbestos until 1979, when a new factory was built using a different production process. METHODS:: We evaluated all workers involved in the entire production history of the company, divided into two subcohorts based on exposure status (workers in the original factory, 1964-1979, and those who worked only in the new factory, 1980-1997). We ascertained the vital status of the study population in February 2001. RESULTS:: Among the subset of workers in the earlier subcohort, there were five deaths from pharyngeal/tonsillar carcinoma for a standardized mortality ratio of 21 (95% confidence interval = 8.8-51). No cases were recorded among workers hired after 1979. CONCLUSION:: The increased standardized mortality ratio for this relatively rare cancer among workers exposed before 1979 may have been due to carcinogenic exposures at the plant.

5. Cocco P, Satta G, Dubois S, Pili C, Pilleri M, Zucca M, 't Mannetje AM, Becker N, Benavente Y, de Sanjosé S, Foretova L, Staines A, Maynadié M, Nieters A, Brennan P, Miligi L, Ennas MG, Boffetta P. Lymphoma risk and occupational exposure to pesticides: results of the Epilymph study. Occup Environ Med. 2013 Feb;70(2):91-8. doi: 10.1136/oemed-2012-100845. Epub 2012 Nov 1.
Department of Public Health, Occupational Health Section, University of Cagliari, Asse Didattico - Policlinico Universitario, SS 554, km 4,500, 09042 Monserrato (Cagliari), Italy;

OBJECTIVES: We investigated the role of occupational exposure to specific groups of agrochemicals in the aetiology of lymphoma overall, B cell lymphoma and its most prevalent subtypes. METHODS: In 1998-2003, 2348 incident lymphoma cases and 2462 controls were recruited to the EPILYMPH case-control study in six European countries. A detailed occupational history was collected in cases and controls. Job modules were applied for farm work including specific questions on type of crop, farm size, pests being treated, type and schedule of pesticide use. In each study centre, industrial hygienists and occupational experts assessed exposure to specific groups of pesticides and individual compounds with the aid of agronomists. We calculated the OR and its 95% CI associated with lymphoma and the most prevalent lymphoma subtypes with unconditional logistic regression, adjusting for age, gender, education and centre. RESULTS: Risk of lymphoma overall, and B cell lymphoma was not elevated, and risk of chronic lymphocytic leukaemia (CLL) was elevated amongst those ever exposed to inorganic (OR=1.6, 95% CI 1.0 to 2.5) and organic pesticides (OR=1.5, 95% CI 1.0 to 2.1). CLL risk was highest amongst those ever exposed to organophosphates (OR=2.7, 95% CI 1.2 to 6.0). Restricting the analysis to subjects most likely exposed, no association was observed between pesticide use and risk of B cell lymphoma. CONCLUSIONS: Our results provide limited support to the hypothesis of an increase in risk of specific lymphoma subtypes associated with exposure to pesticides.

6. Mirabelli D, Cacciatore AM, Ferrante D, Amendola P, Vermeulen R, Merletti F. Cohort study of workers employed in an Italian tire manufacturing plant, 1962-2004. Cancer Causes Control. 2012 Dec;23(12):2023-9. doi: 10.1007/s10552-012-0083-y. Epub 2012 Oct 20.
Unit of Cancer Epidemiology, University of Turin and CPO-Piemonte, via Santena 7, 10125, Turin, Italy.

PURPOSE: To investigate mortality and bladder cancer incidence among workers of a tire manufacturing plant where antioxidants severely contaminated by beta-naphthylamine were never used. METHODS: Mortality follow-up was performed of 9,501 workers first hired between 1962 when the plant started operations and 2000. Person-years of observation from 1962 to 2004, expected deaths, and standardized mortality ratios (SMR) were calculated. Follow-up for bladder cancer incidence from 1988 to 2003 was carried out, and standardized incidence ratios (SIR) were calculated. Multivariable (Poisson) analyses of bladder cancer incidence and mortality by duration of employment (DOE) and time since first employment (TSFE) were performed. RESULTS: Among men, SMRs were significantly reduced for all causes, all cancers, lung cancer, cardiovascular, and ischemic heart diseases. Bladder cancer mortality and leukemia mortality were close to expectation but increased with TSFE. Seventy-two incident cases of bladder cancer were observed (SIR = 1.15; 95 % confidence interval 0.90-1.44), and multivariable analysis suggested a possible increase in rate ratios with DOE. Among women, mortality was close to expectation, but the limited number of observed deaths prevented detailed analyses. CONCLUSIONS: No significant cancer excess was observed. A suggestion of increased risks of bladder cancer and leukemias after extended TSFE was present in men, deserving consideration as exposure to carcinogens possibly occurred early in plant operation. Furthermore, this cohort of workers is still relatively young and less than 10 % have died. There was, thus, limited power to detect small increases in risk at rare cancer sites. Further epidemiological surveillance of this cohort is planned.

7. Peluso M, Bollati V, Munnia A, Srivatanakul P, Jedpiyawongse A, Sangrajrang S, Piro S, Ceppi M, Bertazzi PA, Boffetta P, Baccarelli AA. DNA methylation differences in exposed workers and nearby residents of the Ma Ta Phut industrial estate, Rayong, Thailand. Int J Epidemiol. 2012 Dec;41(6):1753-1760. Epub 2012 Oct 13.
Cancer Risk Factor Branch, Cancer Prevention and Research Institute, Florence, Italy, Department of Occupational and Environmental Health, University of Milan and Istituto Di Ricovero e Cura a Carattere Scientifico Ca' Granda Maggiore Policlinico Hospital, Milan, Italy, Molecular Epidemiology Unit, Research Division, National Cancer Institute, Bangkok, Thailand, Molecular Epidemiology Unit, National Cancer Institute, Genoa, Italy, The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, USA, International Prevention Research Institute, Lyon, France and Laboratory of Environmental Epigenetics, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.

BACKGROUND: Adverse biological effects from airborne pollutants are a primary environmental concern in highly industrialized areas. Recent studies linked air pollution exposures with altered blood Deoxyribo-nucleic acid (DNA) methylation, but effects from industrial sources and underlying biological mechanisms are still largely unexplored. METHODS: The Ma Ta Phut industrial estate (MIE) in Rayong, Thailand hosts one of the largest steel, oil refinery and petrochemical complexes in south-eastern Asia. We measured a panel of blood DNA methylation markers previously associated with air pollution exposures, including repeated elements [long interspersed nuclear element-1 (LINE-1) and Alu] and genes [p53, hypermethylated-in-cancer-1 (HIC1), p16 and interleukin-6 (IL-6)], in 67 MIE workers, 65 Ma Ta Phut residents and 45 rural controls. To evaluate the role of DNA damage and oxidation, we correlated DNA methylation measures with bulky DNA and 3-(2-deoxy-β-D-erythro-pentafuranosyl)pyrimido[1,2-α]purin-10(3H)-one deoxyguanosine (M(1)dG) adducts. RESULTS: In covariate-adjusted models, MIE workers, compared with rural residents, showed lower LINE-1 (74.8% vs 78.0%; P < 0.001), p53 (8.0% vs 15.7%; P < 0.001) and IL-6 methylation (39.2% vs 45.0%; P = 0.027) and higher HIC1 methylation (22.2% vs 15.3%, P < 0.001). For all four markers, Ma Ta Phut residents exhibited methylation levels intermediate between MIE workers and rural controls (LINE-1, 75.7%, P < 0.001; p53, 9.0%, P < 0.001; IL-6, 39.8%, P = 0.041; HIC1, 17.8%, P = 0.05; all P-values vs rural controls). Bulky DNA adducts showed negative correlation with p53 methylation (P = 0.01). M(1)dG showed negative correlations with LINE-1 (P = 0.003) and IL-6 methylation (P = 0.05). CONCLUSIONS: Our findings indicate that industrial exposures may induce alterations of DNA methylation patterns detectable in blood leucocyte DNA. Correlation of DNA adducts with DNA hypomethylation suggests potential mediation by DNA damage.

8. Peluso M, Srivatanakul P, Jedpiyawongse A, Sangrajrang S, Munnia A, Piro S, Ceppi M, Boffetta P, Godschalk RW, van Schooten FJ. Aromatic DNA adducts and number of lung cancer risk alleles in Map-Ta-Phut Industrial Estate workers and nearby residents. Mutagenesis. 2013 Jan;28(1):57-63. doi: 10.1093/mutage/ges053. Epub 2012 Sep 17.
Cancer Risk Factor Branch, Cancer Prevention and Research Institute, Florence, Italy.

The Map-Ta-Phut Industrial Estate (MIE) in Rayong, Thailand, is the location of one of the largest industrial complexes in southeastern Asia. The MIE complex produces a mixture of air pollutants, including polycyclic aromatic hydrocarbons, compounds capable to induce the generation of DNA adducts. DNA adducts are considered to be a biomarker of carcinogen exposure; however, its production can be modulated by genetic susceptibility. Thus, we analysed the influence of EPHX1 His139Arg (A>G, rs2234922) and NQO1 Pro187Ser (C>T, rs1800566) involved in the metabolism of polycyclic aromatic hydrocarbons; MnSOD(2) Val16Ala (C>T, rs1799725) a gene that acts against the free radical generation; APE1/Ref-1 Asp148Glu (T>G, rs3136820) a gene involved in the repair of DNA, and in the control of cell-cycle and apoptosis on leucocyte DNA adducts in 77 MIE workers, 69 Map-Ta-Phut residents, and 50 rural controls, Rayong, Thailand. We searched for associations with the 'sum of at-risk alleles' by combining the variant alleles of EPHX1, NQO1 and MnSOD(2) together with the wild-type allele of APE1, since they appeared to influence lung cancer risk. Although our findings revealed significant associations between DNA adducts and the EPHX1 His139Arg and NQO1 Pro187Ser polymorphisms, the combination of at-risk alleles was found to affect DNA damage much stronger. DNA adducts were significantly increased in the individuals bearing 4 and ≥5 at-risk alleles [mean ratio (MR) = 1.55, 95% CI 1.10-2.18, P = 0.012, and MR = 2.11, 95% CI 1.27-3.51, P = 0.004, respectively)]. After correction for residence/employment categorisation, a significant increment was present in the MIE workers with ≥5 alleles (MR = 2.88, 95% CI 1.46-5.71, P = 0.003). Our data indicate relationships between the generation of DNA adducts and the enzymatic activities of EPHX and NQO1. The combination of unfavourable genetic variants seems to determine the individuals' susceptibility, rather than a single polymorphism.

9. Abballe A, Barbieri PG, di Domenico A, Garattini S, Iacovella N, Ingelido AM, Marra V, Miniero R, Valentini S, De Felip E. Occupational exposure to PCDDs, PCDFs, and PCBs of metallurgical workers in some industrial plants of the Brescia area, northern Italy. Chemosphere. 2013 Jan;90(1):49-56. doi: 10.1016/j.chemosphere.2012.06.073. Epub 2012 Aug 14.
Dipartimento Ambiente e connessa Prevenzione Primaria, Istituto Superiore di Sanità, Roma, Italy.

BACKGROUND: The study was carried out in order to respond to public concern on the occupational exposure of metallurgical workers to highly toxic PCDDs, PCDFs, and PCBs in the area of the city of Brescia, northern Italy. OBJECTIVES: The study investigated the effects on the haematic burden of occupational exposures to the aforesaid contaminants in different work environments, attempting to establish causal relationships and providing indications for occupational health preventive measures. METHODS: Chemical concentrations were measured in blood serum of "professionally exposed" (PE) and "not professionally exposed" (NPE) subjects. NPE subjects included industrial administrative employees, Brescia inhabitants, and remote rural people. RESULTS: The central tendency indexes of contaminant cumulative concentrations were higher in PE than in NPE samples (for the mean values: PCDDs+PCDFs, 22.9 vs. 19.5 pgWHO-TEQ(1997)/g lb; DL-PCBs, 26.0 vs. 23.6 pgWHO-TEQ(1997)/g lb; PCDDs+PCDFs+DL-PCBs (TEQ(TOT)), 48.9 vs. 43.1 pgWHO-TEQ(1997)/g lb; Σ(6)[NDL-PCBs], 427 vs. 401 ng g(-1)lb); however, no statistical differences were detected at P=0.05. A significant difference for PCDDs+PCDFs and TEQ(TOT) was observed as the NPE data were progressively reduced to those of the remote rural people. The existence of a differential occupational exposure due to different environments was detected by applying the factor analysis to congener-specific data (analytical profiles). CONCLUSIONS: Findings indicate that metallurgical workers may be exposed to PCDD, PCDF, and PCB more than the general population, in particular due to non-negligible contributions to exposure from workplace ambient air. Findings also suggest that an improvement of preventive measures may be required to avoid chemical overexposure in certain metallurgical workplaces. To identify exposure groups, the DL- and NDL-PCB analytical profiles seemed to be more sensitive to environmental exposure sources/pathways than those of PCDDs and PCDFs.

10. Rui F, Bovenzi M, Prodi A, Fortina AB, Romano I, Corradin MT, Filon FL. Concurrent sensitization to metals and occupation Contact Dermatitis. 2012 Dec;67(6):359-66. doi: 10.1111/j.1600-0536.2012.02100.x. Epub 2012 May 12.
Clinical Unit of Occupational Medicine, Department of Medical Sciences, University of Trieste, Trieste 34129, Italy.

BACKGROUND: Cosensitization to nickel, cobalt and chromium occurs in the general population and in some occupational groups. OBJECTIVES: To estimate the isolated and concurrent occurrence of nickel, cobalt and chromium contact sensitization and their association with individual and occupational risk factors. PATIENTS/METHODS: Twelve thousand four hundred and ninety-two patients were patch tested with the European baseline series between 1997 and 2004 in north-eastern Italy. The associations between patch test results and patient characteristics and occupations were investigated by means of multinomial logistic regression analysis. RESULTS: Of the patients, 34.7% (4334 patients) had one or more positive patch test reactions to metals. As compared with those with negative reactions to all three metals, nickel sensitization was significantly higher in females than in males, not only as monosensitization, but also as cosensitization with cobalt, with chromium, or with both metals. Building and related trades workers showed positive reactions to chromium + nickel [odds ratio (OR) 1.99; 95% confidence interval (CI) 1.05-3.76) and chromium + cobalt (OR 2.61; 95% CI 1.46-4.67]. Cleaning workers showed a high prevalence of nickel, chromium, nickel + chromium and nickel + cobalt + chromium cosensitization (ORs 1.29, 1.66, 2.11, and 1.79, respectively). An excess risk for cosensitization to all three metals was found in textile and leather workers (OR 2.19; 95% CI 1.10-4.33), and in bartenders (OR 2.10; 95% CI 1.03-4.26). CONCLUSIONS: Some occupational groups are more likely to develop nickel, cobalt and chromium cosensitization.

11. Ciarrocca M, Tomei G, Palermo P, Caciari T, Cetica C, Fiaschetti M, Gioffrè PA, Tasciotti Z, Tomei F, Sancini A. Environmental and biological monitoring of arsenic in outdoor workers exposed to urban air pollutants. Int J Hyg Environ Health. 2012 Nov;215(6):555-61. doi: 10.1016/j.ijheh.2011.11.014. Epub 2011 Dec 24.
Department of Occupational Medicine, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.

The aim of this study is to evaluate personal exposure to As in urban air in two groups of outdoor workers (traffic policemen and police drivers) of a big Italian city through: (a) environmental monitoring of As obtained by personal samples and (b) biological monitoring of total urinary As. The possible influence of smoking habit on urinary As was evaluated. We studied 122 male subjects, all Municipal Police employees: 84 traffic policemen and 38 police drivers exposed to urban pollutants. Personal exposure to As in air was significantly higher in traffic policemen than in police drivers (p=0.03). Mean age, length of service, alcohol drinking habit, number of cigarettes smoked/day and BMI were comparable between the groups of subjects studied. All subjects were working in the same urban area where they had lived for at least 5 yrs. Dietary habits and consumption of water from the water supply and/or mineral water were similar in traffic policemen and in police drivers. The values of total urinary As were significantly higher in traffic policemen (smokers and non smokers) than in police drivers (smokers and non smokers) (p=0.02). In the subgroup of non-smokers the values of total urinary As were significantly higher in traffic policemen than in police drivers (p=0.03). In traffic policemen and in police drivers total urinary As values were significantly correlated to the values of As in air (respectively r=0.9 and r=0.8, p<0.001). This is the first research in literature studying the exposure to As in outdoor workers occupationally exposed to urban pollutants, such as traffic policemen and police drivers. Personal exposure to As in the air, as well as the urinary excretion of As, is significantly higher in traffic policemen compared to drivers. These results can provide information about exposure to As in streets and in car for other categories of outdoor workers similarly exposed.

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